Treatment for Male Factor Infertility
For many years, infertility used to be perceived as a predominantly female disease. However, for today it has been proved that cases of infertility are comparable in numbers for both male and female factors. According to statistics, for about 1 million of infertile couples, in 30-40% of cases the male factor infertility appears to be the reason of infertility in a couple. Man’s reproduction ability depends on the quality and quantity of semen. Fertilizing capacity of semen is characterized with the quantity of sperm cells in 1 ml of semen. In a normal range, it is equal to 60-120 million. Since sexual maturation and until death the male organism releases sperm cells permanently (more than 1,000 per a second). Unfortunately, many diseases and factors can cause abnormalities resulting in male fertility problems in this process.
If during one year, a couple of reproductive age has unprotected sexual relations and pregnancy does not occur, it is necessary to visit a fertility specialist. A man should visit an andrologist (male fertility doctor) who will gather past medical history (child’s and urogenital diseases, surgical interference, different toxicopathy and professional injury), will do examinations and appoint laboratory analyses, on the basis of which any kind of male infertility can be detected. A spermogram is an indispensable part of male infertility treatment.
According to the results of male fertility tests, different causes can be diagnosed:
- Oligospermatism – concentration of sperm cells is lower than standard value (20 million in 1 ml of semen).
- Asthenozoospermia – reduction of standard sperm motility in semen.
- Teratozoospermia – low quantity (less than 50%) of sperm cells with standard shape of head and tail is detected in semen.
- Azoospermia – absence of sperm cells in ejaculate.
Three types of male infertility can be determined in medical practice:
Secretory infertility. The most widespread type of male infertility. It is an abnormality of normal testes function (reduction of quality, quantity and motility of sperm cells). A range of diseases can lead to the development of secretory infertility: varicocele, hydrocele, inguinal hernia, cryptorchidism (when testis is not dropped inside the marsupium), epidemic parotiditis, and also lues venerea and tisis. An advanced and proper treatment of these diseases can decrease a risk of male infertility.
Obturative infertility – inability of sperm cells to move through deferent canals. Blocking can be from one side and also from both sides. Treatment of this type of male infertility presume surgery interference. Causes of obturative male infertility: congenital defect, the result of injuries and after-effect of such diseases as epididymitis (inflammation of epididymis), lues venerea, tisis. Other widespread causes of blocking canals can be cystisis, blastoma and cicatrix that was a result of carried surgeries.
Immunological infertility is characterized with formation in a man’s body ofantispermal antibodies, which will cause abnormality of normal spermatogenesis and also prevent normal fertilization of the oocyte. Such antibodies mostly form as a result of injuries of testis, besides their formation can be influenced by different urogenital infections – chlamydia, mycoplasma and others.
Male infertility treatment
In most cases (up to 95%) treatment of male infertility leads to successful results.
Depending on the type and cause of a disease, different approaches can be applied. In some cases, change of lifestyle and refusal from bad habits can be enough. In other cases, fertilization can occur only in IVF cycles with appliance of advanced procedures of fertilization ICSI, IMSI, PICSI. Some abnormalities can demand appliance of testis biopsy TESA in order to collect sperm cells for IVF. An experienced andrologist (male fertility doctor) will help to understand the problem and provide an effective treatment.
The treatment includes three main stages:
- Determination of causes, in other words examination and diagnosis.
- Treatment of diseases and removal of factors which depress spermatogenesis. Beginning from therapy of virulent disease and up to surgery cure of abnormality.
- Stimulation of spermatogenesis and/or collection of sperm cells of good quality.
The main methods of treatment for male infertility are:
Hormonotherapy. Usage of special biologically active preparations is prescribed while impaired spermatogenesis (reduction of mobility and quantity of sperm cells in semen). Hormonotherapy can be applied as an independent treatment but more often, it is applied as a part of multimodality treatment. Usually it lasts no less than 9 months under the regular control of a doctor. The choice of hormone preparation depends on the type of pathobiology. The preparations are prescribed entirely by a doctor on the ground of test results. Doctor also estimates the dosage needed for each individual patient.
Stimulation of spermatogenesis. Temporary improvement of the quality of sperm can be accomplished with the help of medicated preparations. Hormonal preparations and vitamins, which positively influence the production of sperm cells, can be prescribed for the stimulation of spermatogenesis. A fertility specialist will do the choice of preparations depending on individual characteristics of a patient and indications. The stimulation can be prescribed as for the naturally occurring conception and also for IVF or artificial insemination. After the stimulation, the quality of sperm improves on 30-40%.
TESA/TESE. In case of lack of normal sperm cells in semen, they can be obtained by testicle biopsy. Obtained sperm cells can be used for in vitro fertilization or artificial insemination. Testicular biopsy can be conducted with two methods:
ТЕSА — a fine-needle aspiration biopsy, less invasive method of obtaining sperm cells.
ТЕSЕ — a microsurgical microfocal biopsy of the testis, while which bigger (in comparison with TESA) quantity of testicular tissue is collected.
Both manipulations are held under the intravenous anesthesia.
There are some diseases, which does not allow collecting normal sperm cells. Than a couple can use donor sperm.
In conclusion, it should be mentioned that normal man’s sexual function does not guaranty absence of reproductive problems. Only skilled specialist can accurately define a cause of infertility of a couple on the grounds of complete examination of both partners.